M.K. Bhondeley

Prevalence of pulmonary tuberculosis amongst the tribal population of Madhya Pradesh, central India

BACKGROUND This was a prevalence survey of pulmonary tuberculosis (PTB) disease in the tribal population of Madhya Pradesh state, central India. METHODS A community-based cross-sectional tuberculosis (TB) disease prevalence survey was undertaken among adults aged > or = 15 years in the tribal population of Madhya Pradesh. A multistage stratified cluster sampling was adopted. A representative random sample of villages predominated by tribal populations was selected from 11 districts. All eligible individuals were questioned for chest symptoms relating to TB. Sputum samples were collected from all eligible individuals, transported to the laboratory, and examined by Ziehl-Neelsen (ZN) smear microscopy and solid media culture methods. RESULTS Of the 23,411 individuals eligible for screening, 22,270 (95.1%) were screened for symptoms. The overall proportion of symptomatic individuals was 7.9%. Overall prevalence (culture and/or smear positive) of PTB was 387 [95% confidence interval (CI): 273-502] per 100,000 population. The prevalence increased with age and was also significantly higher among males (554/100,000; 95% CI: 415-693) as compared with females (233/100,000; 95% CI: 101-364) (P < 0.001). CONCLUSION The findings suggest that the TB situation amongst the tribal population is not that different from the situation among the non-tribal population in the country. However, TB remains a major public health problem amongst the tribal population and there is a need to maintain and further strengthen TB control measures on a sustained and long-term basis.

Prevalence of Pulmonary Tuberculosis - A Baseline Survey In Central India

Background The present study provides an estimate of the prevalence of bacteriologially positive pulmonary tuberculosis in Jabalpur, a district in central India. Methodology/Principal Findings A community based cross-sectional survey was undertaken in Jabalpur District of the central Indian state of Madhya Pradesh. A stratified cluster sampling design was adopted to select the sample. All eligible individuals were questioned for pulmonary symptoms suggestive of TB disease. Two sputum samples were collected from all eligible individuals and were examined by Ziehl-Neelsen smear microscopy and solid media culture methods. Of the 99,918 individuals eligible for screening, 95,071 (95.1%) individuals were screened. Of these, 7,916 (8.3%) were found to have symptoms and sputum was collected from 7,533 (95.2%) individuals. Overall prevalence of bacteriologically positive PTB was found to be 255.3 per 100,000 population (95% C.I: 195.3–315.4). Prevalence was significantly higher (p<0.001) amongst males (355.8; 95% C.I: 304.4–413.4) compared with females (109.0; 95% C.I: 81.2–143.3). Prevalence was also significantly higher in rural areas (348.9; 95% C.I: 292.6–412.8) as compared to the urban (153.9; 95% C.I: 123.2–190.1). Conclusions/Significance The TB situation in Jabalpur district, central India, is observed to be comparable to the TB situation at the national level (255.3 versus 249). There is however, a need to maintain and further strengthen TB control measures on a sustained and long term basis in the area to have a significant impact on the disease prevalence in the community.

Seroprevalence of sexually transmitted viruses in the tribal population of Central India.

OBJECTIVE To determine the seroprevalence of human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV, HCV), and herpes simplex virus type 2 (HSV-2) in the tribal population of central India. METHODS A community-based cross-sectional survey was carried out in the tribal population of Jabalpur district. Blood samples were drawn from 326 patients with sexually transmitted infections (STIs) and 526 randomly selected adults. These were tested for HIV, HBV, HCV, and HSV-2 using commercial ELISA kits. RESULTS The prevalence of IgG antibodies to HSV-2 was 20.8% in STI patients compared to 12.4% in the general population. The HBV carriage rate was 3.4% in STI patients against 2.9% in the general population. HCV prevalence was 3.9% in STI patients and 4.6% in the general population. No HIV infection was found in the study population. CONCLUSIONS In view of the high prevalence of viral STIs in the tribal community of Central India, there is a need to strengthen the STI control program in this under-privileged group.

Tuberculous infection in Saharia a primitive tribal community of Central India.

A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1-9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72 h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11 mm and a mode at 18 mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2-22.5%) and the ARTI was 3.9% (95% CI 3.5-4.3%). The corresponding figures were 21.1% (95% CI 18.3-23.8%) and 3.9% (95% CI 3.4-4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4-22.5%) and 4.0% (95% CI 3.2-4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area.

Tobacco smoking: a major risk factor for pulmonary tuberculosis – evidence from a cross-sectional study in central India

BACKGROUND This paper provides information on the association of tobacco smoking and alcohol consumption with pulmonary TB (PTB) in central India. METHODS A community based cross-sectional TB prevalence survey was conducted in Jabalpur district of the central Indian state of Madhya Pradesh. The information on tobacco smoking and alcohol consumption was collected from individuals aged ≥15 years. Using logistic regression analysis, the risk factors for PTB were identified. RESULTS A total of 94 559 individuals provided information on tobacco smoking and alcohol consumption. Persons aged 35-54 years and 55 years and above had, respectively, a 2.19 (95% CI 1.57-3.07) and a 3.26 (95% CI 2.23-4.77) times higher risk of developing PTB compared to persons aged below 35 years. Males had a 2.35 (95% CI 1.66-3.32) times higher risk than females. Tribals (indigenous population) had a 2.32 (95% CI 1.68-3.21) times higher risk than non-tribal population. The adjusted prevalence odds ratio for mild, moderate and heavy tobacco smokers were 2.28, 2.51 and 2.74 respectively as compared to non-smokers. Alcohol consumption was not found to be a risk factor on multivariate analysis. CONCLUSION Tobacco smoking is significantly associated with PTB in this central Indian district. Smoking cessation services need to be integrated into the activities of the TB control programme.

Smoking and alcohol consumption: Risk factors for pulmonary tuberculosis among the tribal community in central India

Smoking and alcohol consumption are important risk factors for pulmonary tuberculosis (PTB). A cross-sectional survey was undertaken among the Gond tribe in Jabalpur district of Madhya Pradesh, and information on smoking and alcohol consumption was collected. As compared to females, males had an increased odds for PTB prevalence (odds ratio (OR) 3.2; 95% CI 486.4-1358.4; p=0.01). Similarly smokers and alcohol consumers had an increased odds for PTB compared to non-smokers and non-alcohol consumers, respectively [(OR 3.2; 95% CI 516.4-1986.4; p=0.003); (OR 3.2; 95% CI 480.8-2254.8; p=0.009)]. Persons who were both smokers and alcohol consumers had an equally increased odds of PTB than those who did not smoke and consumed alcohol (OR 4.1; 95% CI 477.6-2581.6; p=0.001). The study findings highlight the need to develop and implement culturally appropriate awareness raising activities among the tribal community to support TB control efforts.

Health literacy on tuberculosis amongst vulnerable segment of population: special reference to Saharia tribe in central India

Background & objectives: Health literacy on tuberculosis (TB) is an understanding about TB to perform activities with regard to prevention, diagnosis and treatment. We undertook a study to assess the health literacy on TB among one of the vulnerable tribal groups (Saharia) in central India. Methods: In this cross-sectional study, 2721 individuals aged >15 yr from two districts of Madhya Pradesh State of India were interviewed at their residence during December 2012-July 2013. By using a short-form questionnaire, health literacy on cause, symptoms, mode of transmission, diagnosis, treatment and prevention of TB was assessed. Results: Of the 2721 (Gwalior 1381; Shivpuri 1340) individuals interviewed; 76 per cent were aged <45 yr. Living condition was very poor (62% living in huts/katcha houses, 84 per cent with single room, 89 per cent no separate kitchen, 97 per cent used wood/crop as a fuel). Overall literacy rate was 19 per cent, and 22 per cent had >7 members in a house. Of the 2721 respondents participated, 52 per cent had never heard of TB; among them 8 per cent mentioned cough as a symptom, 64 per cent mentioned coughing up blood, and 91 per cent knew that TB diagnosis, and treatment facilities were available in both government and private hospitals. Health literacy score among participants who had heard of TB was <40 per cent among 36 per cent of respondents, 41-60 per cent among 54 per cent and >60 per cent among 8 per cent of respondents. Interpretation & conclusions: The finding that nearly half of the respondents had not heard of TB indicated an important gap in education regarding TB in this vulnerable population. There is an urgent need to implement targeted interventions to educate this group for better TB control.

Pulmonary tuberculosis - a health problem amongst Saharia tribe in Madhya Pradesh

Background & objectives: The information on tuberculosis (TB) situation amongst Saharia, one of the particularly vulnerable tribal groups (PVTGs) in Madhya Pradesh, is not available from Gwalior division of the State. Hence, this study was undertaken to estimate the prevalence of pulmonary tuberculosis (PTB) disease amongst them. Methods: A community based cross-sectional TB prevalence survey was undertaken among Saharia PVTG in Gwalior district of Madhya Pradesh. A random sample of villages predominated by Saharia tribe was selected from all the blocks in proportion to the size of Saharia population in each block of the district. All eligible individuals were questioned for chest symptoms relating to TB. Two sputum samples were collected from each of the eligible individuals, transported to the laboratory, and were examined by Ziehl-Neelsen(ZN) smear microscopy and solid media culture methods. Results: Of the total 10,259 individuals eligible for screening, 9,653 (94.1%) were screened for symptoms. Overall prevalence of PTB was found to be 3294 per 100,000. The prevalence increased with age and the trend was significant (P<0.001). The prevalence of TB was significantly higher amongst males (5497/100,000) as compared to females (1376/100,000) (P<0.001). Interpretation & conclusions: The study results provide vital information on the current situation of pulmonary TB disease among the Saharia tribal community in Gwalior district of Madhya Pradesh. In view of high PTB disease prevalence among this PVTG, there is an urgent need to improve and further intensify TB control measures in this area.

Yield of pulmonary tuberculosis cases by symptoms: Findings from a community survey in Madhya Pradesh, central India.

A cross-sectional tuberculosis prevalence survey was undertaken in Jabalpur district, Madhya Pradesh, central India. All individuals were questioned for chest symptoms. Sputum samples were collected and examined for microscopy and culture. Overall prevalence of sputum positive pulmonary tuberculosis was found to be 255.3 per 100,000 population. Cough, with or without other symptoms, was present in 75.5% individuals and yielded 88.2% of the detected pulmonary tuberculosis cases. Elicitation of a previous history of treatment yielded 5.9%, and chest pain 4.5% cases. History of fever alone yielded no cases. The findings suggest that a history of fever alone may be safely excluded from the list of symptoms to be elicited in future TB prevalence surveys in India.